WM0801161_Application_20200814

;ETC
ENVIRONMENTAL• GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
August 6, 2020
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax:[phone]
www.atcassociates.com
N.C. Engineering License No. C-1598
Ms. Morella Sanchez -King
North Carolina Department of Environmental Quality
Wilmington Regional Office
Division of Water Resources — Water Quality Regional Operations Section
127 Cardinal Drive Ext.
Wilmington, North Carolina 28405
Re: Permits to Construct Monitoring Wells
Coastal Cleaners
345 Western Blvd.
Jacksonville, Onslow County, North Carolina
DSCA Site No. DC670011
Dear Ms. Sanchez -King:
Enclosed please find two permit applications to construct two monitoring wells. The monitoring
wells will be located at 353 Western Boulevard (PIN 438715540053) and 380 Western
Boulevard (PIN 438715544142) in Jacksonville, North Carolina. The permit applications, site
maps with the proposed locations of the permanent monitoring wells, well construction details
and other relevant information are enclosed as attachments. Please review this package and
return the approved permits to this office.
If you have any questions or require additional information, please contact our office at (919)
871-0999.
Sincerely,
ATC Associates of North Carolina, P.C.
Emily J. Fuller
Project Scientist
Email to both: morella.sanchez-king@a ncdenr.gov
-e�gleynncdenr.gov

NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY - DIVISION OF WATER RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT A MONITORING OR RECOVERY WELL SYSTEM
PLEASE TYPE OR PRINT CLEARLY
1.
2.
3.
4.
5.
6.
7.
8.
9.
10
In accordance with the provisions of Article 7, Chapter 87, General Statutes of North Carolina and regulations pursuant thereto,
application is hereby made for a permit to construct monitoring or recovery wells.
Date: 08/06/2020
County: Onslow
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
What type of well are you applying for? (monitoring or recovery): Monitoring
Applicant: KM Corporation (Petitioner for DSCA site #DC670011) Telephone: [phone]
Applicant's Mailing Address: DSCA Program, Mail Service Center 1646, Raleigh, NC 27699-1646
Applicant's Email Address (if available): Sue. Murphy6d�ncdenr.gov
Contact Person (if different than Applicant): Emily Fuller, ATC Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh, NC 27604
Contact Person's Email Address (if available): emily.fuller atcgs.com
Property Owner (if different than Applicant): Green Real Estate, LLC Telephone: [phone]
Property Owner's Mailing Address: 739 Red Banks Road, Greenville, NC 27858
Property Owner's Email Address (if available): taojacksonville(a-.yahoo.com
Property Physical Address (Including PIN Number) 353 Western Blvd (PIN: 438715540053)
City Jacksonville County Oslow Zip Code 28546
Reason for Well(s): Groundwater Contamination
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
Type of facility or site for which the well(s) is(are) needed: Dry-cleaner
(ex: non -discharge facility, waste disposal site, landfill, UST, etc.)
Are there any current water quality permits or incidents associated with this facility or site? If so, list permit and/or incident no(s).
DSCA # DC670011
11. Type of contaminants being monitored or recovered: Chlorinated Solvents
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes -Four
Existing Monitoring or Recovery Well Construction Permit No(s): WM0801130 and WM0801107
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet):
70 feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes, give distance(s): N/A
15. Well Contractor: Innovative Environmental Technologies, Inc. Certification No.: 3287-B
Well Contractor Address: 232 Highway 49 S, Concord, NC 28025
PROPOSED WELL CONSTRUCTION INFORMATION
As required by 15A NCAC 02C .0105(f)(7), attach a well construction diagram of each well showing the following:
a. Borehole and well diameter e. Type of casing material and thickness
b. Estimated well depth f. Grout horizons
C. Screen intervals g. Well head completion details
d. Sand/gravel pack intervals
Continued on Reverse

PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated 5. How will the well(s) be secured? Locking well cap,
material: 1 Flush -mount steel protective casing.
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 10/12/20
4. Total Number of wells to be constructed: 1 7. Estimated construction completion date: 10/13/20
(add answers from 2 and 3)
ADDITIONAL INFORMATION
1. As required by 15A NCAC 02C .0105(f)(5), attach a scaled map of the site showing the locations of the following:
a. All property boundaries, at least one of which is referenced to a minimum of two landmarks such as identified roads,
intersections, streams, or lakes within 500 feet of the proposed well or well system.
b. All existing wells, identified by type of use, within 500 feet of the proposed well or well system.
C. The proposed well or well system.
d. Any test borings within 500 feet of proposed well or well system.
e. All sources of known or potential groundwater contamination (such as septic tank systems, pesticide, chemical or fuel
storage areas, animal feedlots as defined in G.S. 143-215.10B(5), landfills, or other waste disposal areas) within 500 feet
of the proposed well or well system.
SIGNATURES
The Applicant hereby agrees that the proposed well(s) will be constructed in accordance with approved specifications and conditions of
this Well Construction Permit as regulated under the Well Construction Standards (Title 15A of the North Carolina Administrative Code,
Subchapter 2C) and accepts full responsibility for compliance with these rules
� 1 1 ''1
Signature of Applicant or *Agent
Emily Fuller (Agent for Petitioner for DSCA Site #670011
Printed name of Applicant or *Agent
Agent for DSCA Site DC670011 (will include power of attorney
Title of Applicant or *Agent upon request)
* If signing as Agent, attach authorization agreement stating
that you have the authority to act as the Agent.
If the property is owned by someone other than the applicant, the property owner hereby consents to allow the applicant to construct
wells as outlined in this Well Construction Permit application and that it shall be the responsibility of the applicant to ensure that the
well(s) conform to the Well Construction Standards (Title 15A of the North Carolina Administrative Code, Subchapter 2C).
See attached access agreement See attached access agreement
Signature of Property Owner (if different than Applicant) Printed name of Property Owner (if different than Applicant)
DIRECTIONS
Please send the completed application to the appropriate Division of Water Resources' Regional Office:
Asheville Regional Office Raleigh Regional Office Wilmington Regional Office
2090 U.S. Highway 70 3800 Barrett Drive 127 Cardinal Drive Extension
Swannanoa, NC 28778 Raleigh, NC 27609 Wilmington, NC 28405
Phone: [phone] Phone: [phone] Phone: [phone]
Fax: [phone] Fax: [phone] Fax: [phone]
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301-5094
Phone: [phone]
Fax: [phone]
Mooresville Regional Office
610 East Center Avenue
Mooresville, NC 28115
Phone: [phone]
Fax: [phone]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
OR Rev. 3-1-2016

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
MICHAEL SCOTT
Director
NORTH CAROLINA
Environmental Quality
PROPERTY ACCESS CONSENT
This docuutent rt:ay not be modified without the Progrant's approval.
If you have questions on how to fill out this form or about the activities
at this site, please call the Dry -Cleaning Solvent. Cleanup Act (DSCA)
Program's contractor for this project, Emily Fuller with ATC
Assoctates ofort N h C l' P C l full g t 919
For DSCA Use Only
DSCA ID No.
DC670011
)
aro tna, P.C. at emt y. et ,a c sg cam or (
871-0999. If you still have questions after contacting Ms. Fuller with AC, please
contact the DSCA project manager, Sue Murphy at sue.murphyLa nedenngov or
(919) 7074354.
Please Print
p.: r
(Name of Property Owner or Tenant in Residence)
353 Western Boulevard
(Street Number and Street Name of Property)
Jacksonville Onslow 28546
(City or Town in Which Property Is Located) / (County in Which Property is Located) / (Zip Code)
I voluntarily consent to the Division of Waste Management (Division) and its independent
contractors (contractors) entering and having continued access to my property for the following
purposes:
(1) taking such soil, groundwater and/or air samples as may be necessary;
(2) taking other actions related to the investigation of surface or subsurface conditions;
(3) taking response actions necessary to mitigate any threat to human health or the environment.
Other conditions:
(1) The Division and its contractors shall attempt to perform any activities at the Property in a
manner that minimizes interference with use of the Property.
t,;th C�rslrs� gr~par trrnt a! Errvtroornrnial Quairty I Divlstnn of W�astc pia anent
i17 west Jartts Street 1 ib=#6 A41 Servies Gcrttrr ! R.t!eiqtr, Noah C�rt� 271>R9�1h9C;
919.7A1,a2Ci6

(2) On conclusion of all activities, the Division and its contractors shall, to the extent practicable,
restore the Property to the original condition it was in prior to any activities conducted by the
Division or its contractors. All monitoring wells will be properly abandoned in accordance
with applicable laws and regulations, unless other arrangements are agreed to by the Property
Owner.
(3) The Division or its contractors will make reasonable attempts to notify the Property Owner at
least 48 hours prior to entering the Property for any purpose. In situations that the Division
determines to be of an emergency nature, the Division or its contractors shall have immediate
access to the property.
(4) Property Owner shall not willingly destroy, damage, remove, pave over or cover any
monitoring wells at the site without prior consent of the Division.
By signing this consent document, I acknowledge that I am the legal property owner or tenant
in residence that has the authority to allow this work on the property and have contacted all
tenants (if there are tenants) occupying the property and all tenants agree to the conditions
of this "Property Access Consent".
(Sign�t�re'o'f Property Owner or Tenant in Residence) (Date)
for Property Owner or Tenant in Residence for scheduling work/notification)
(Email Addr` ss for Property Owner or
email)
Please return form to:
Emily J. Fuller
ATC Associates of North Carolina, P.C.
2725 East Milibrook Road, Suite 121
Raleigh, NC 27604
Or via email to: [e-mail]
in Residence if you prefer to be contacted via
Ncth G�r�l�rt� t7�p;�rint of Envirartr+nenial Qu;xfzly I C7ivit0gn of 4Vaxte t�la �m�nt
21i \�t�st J�nt� Strert l Itrib MA 5ovice Cct>ter 1 Rjriy, North Ca?'�`in.� 27ii9�•ita�ta
919,707A200

NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY - DIVISION OF WATER RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT A MONITORING OR RECOVERY WELL SYSTEM
PLEASE TYPE OR PRINT CLEARLY
1.
2.
3.
4.
5.
6.
7.
8.
9.
10
11
12
13
In accordance with the provisions of Article 7, Chapter 87, General Statutes of North Carolina and regulations pursuant thereto,
application is hereby made for a permit to construct monitoring or recovery wells.
Date: 08/06/2020
County: Onslow
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
What type of well are you applying for? (monitoring or recovery): Monitoring
Applicant: KM Corporation (Petitioner for DSCA site #DC670011) Telephone: [phone]
Applicant's Mailing Address: DSCA Program, Mail Service Center 1646, Raleigh, NC 27699-1646
Applicant's Email Address (if available): Sue. Murphy6d�ncdenr.gov
Contact Person (if different than Applicant): Emily Fuller, ATC Telephone: [phone]
Contact Person's Mailing Address: 2725 E. Millbrook Road, Suite 121, Raleigh, NC 27604
Contact Person's Email Address (if available): emily.fuller atcgs.com
Property Owner (if different than Applicant): MK Menlo II Property Owner, LLC c/o Rite Aid Corporation
Telephone: Not Provided
Property Owner's Mailing Address: P.O. Box 3165, Harrisburg, PA 17105
Property Owner's Email Address (if available): Not Provided
Property Physical Address (Including PIN Number) 380 Western Blvd (PIN: 4387155441
City Jacksonville County Oslow Zip Code 28546
Reason for Well(s): Groundwater Contamination
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
Type of facility or site for which the well(s) is(are) needed: Dry-cleaner
(ex: non -discharge facility, waste disposal site, landfill, UST, etc.)
Are there any current water quality permits or incidents associated with this facility or site? If so, list permit and/or incident no(s).
DSCA # DC670011
Type of contaminants being monitored or recovered: Chlorinated Solvents
(ex: organics, nutrients, heavy metals, etc.)
Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes- Four
Existing Monitoring or Recovery Well Construction Permit No(s): WM0801130 and WM0801107
Distance from proposed well(s) to nearest known waste or pollution source (in feet): 200 feet
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes, give distance(s): N/A
15. Well Contractor: Innovative Environmental Technologies, Inc. Certification No.: 3287-B
Well Contractor Address: 232 Highway 49 S, Concord, NC 28025
PROPOSED WELL CONSTRUCTION INFORMATION
As required by 15A NCAC 02C .0105(f)(7), attach a well construction diagram of each well showing the following:
a. Borehole and well diameter e. Type of casing material and thickness
b. Estimated well depth f. Grout horizons
C. Screen intervals g. Well head completion details
d. Sand/gravel pack intervals

Continued on Reverse
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated 5. How will the well(s) be secured? Locking well cap,
material: 1 Flush -mount steel protective casing.
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: 10/12/20
4. Total Number of wells to be constructed: 1 7. Estimated construction completion date: 10/13/20
(add answers from 2 and 3)
ADDITIONAL INFORMATION
1. As required by 15A NCAC 02C .0105(f)(5), attach a scaled map of the site showing the locations of the following:
a. All property boundaries, at least one of which is referenced to a minimum of two landmarks such as identified roads,
intersections, streams, or lakes within 500 feet of the proposed well or well system.
b. All existing wells, identified by type of use, within 500 feet of the proposed well or well system.
C. The proposed well or well system.
d. Any test borings within 500 feet of proposed well or well system.
e. All sources of known or potential groundwater contamination (such as septic tank systems, pesticide, chemical or fuel
storage areas, animal feedlots as defined in G.S. 143-215.10B(5), landfills, or other waste disposal areas) within 500 feet
of the proposed well or well system.
SIGNATURES
The Applicant hereby agrees that the proposed well(s) will be constructed in accordance with approved specifications and conditions of
this Well Construction Permit as regulated under the Well Construction Standards (Title 15A of the North Carolina Administrative Code,
Subchapter 2C) and accepts full responsibility for compliance with these rules
Signature of Applicant or *Agent
Emily Fuller (Agent for Petitioner for DSCA Site #670011)
Printed name of Applicant or *Agent
Agent for DSCA Site DC670011 (will include power of attorney
Title of Applicant or *Agent upon request)
* If signing as Agent, attach authorization agreement stating
that you have the authority to act as the Agent.
If the property is owned by someone other than the applicant, the property owner hereby consents to allow the applicant to construct
wells as outlined in this Well Construction Permit application and that it shall be the responsibility of the applicant to ensure that the
well(s) conform to the Well Construction Standards (Title 15A of the North Carolina Administrative Code, Subchapter 2C).
See attached access agreement See attached access agreement
Signature of Property Owner (if different than Applicant) Printed name of Property Owner (if different than Applicant)
DIRECTIONS
Please send the completed application to the appropriate Division of Water Resources' Regional Office:
Asheville Regional Office Raleigh Regional Office Wilmington Regional Office
2090 U.S. Highway 70 3800 Barrett Drive 127 Cardinal Drive Extension
Swannanoa, NC 28778 Raleigh, NC 27609 Wilmington, NC 28405
Phone: [phone] Phone: [phone] Phone: [phone]
Fax: [phone] Fax: [phone] Fax: [phone]
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301-5094
Phone: [phone]
Fax: [phone]
Mooresville Regional Office
610 East Center Avenue
Mooresville, NC 28115
Phone: [phone]
Fax: [phone]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
3W-22MR Rev. 3-1-2016

ROY COOPER NORTH CAROLINA
Governor Environmental Quality
MICHAEL S. REGAN
Secretary
MICHAEL SCOTT
Director
PROPERTY ACCESS CONSENT
This document may not be modified without the Program's approval. For DSCA Use Only
If you have questions on how to fill out this form or about the activities DSCA ID No.
at this site, please call the Dry -Cleaning Solvent Cleanup Act (DSCA)
Program's contractor for this project, Emily Fuller with ATC DC670011
Associates of North Carolina, P.C. at emily.fuller a,atc s� com or (919)
871-0999. Ifyou still have questions after contacting Ms. Fuller with ATC, please
contact the DSCA project manager, Sue Murphy at suc.murphvLUncdenngov or
[phone].
Please Print
(Name of Property Owner or Tenant in Residence)
380 Western Boulevard
(Street Number and Street Name of Property)
Jacksonville Onslow 28546
(City or Town in Which Property Is Located) / (County in Which Property is Located) / (Zip Code)
I voluntarily consent to the Division of Waste Management (Division) and its independent
contractors (contractors) entering and having continued access to my property for the following
purposes:
(1) taking such soil, groundwater and/or air samples as may be necessary in the location identified
on the attached Property Access Map;
(2) taking other actions related to the investigation of surface or subsurface conditions as may be
approved by the undersigned in writing;
(3) taking response actions necessary to mitigate any threat to human health or the environment as
may be approved by the undersigned in writing.
a_E �-�
sw�
North Carolina Department of Envirorunental Quality ! Division of Waste Management
217 West Jones Street 1 Ib46 Mall Service Center Raleigh. North Carolina 27699 1&46
919.707.8200

Other conditions:
(1) The Division and its contractors shall attempt to perform any activities at the Property in a
manner that minimizes interference with use of the Property.
(2) On conclusion of all activities, the Division and its contractors shall, to the extent practicable,
restore the Property to the original condition it was in prior to any activities conducted by the
Division or its contractors. All monitoring wells will be properly abandoned in accordance
with applicable laws and regulations, unless other arrangements are agreed to by the Property
Owner.
(3) The Division or its contractors will make reasonable attempts to notify the Property Owner at
least 48 hours prior to entering the Property for any purpose. In situations that the Division
determines to be of an emergency nature, the Division or its contractors shall have immediate
access to the property.
(4) Property Owner shall not willingly destroy, damage, remove, pave over or cover any
monitoring wells at the site without prior consent of the Division.
Special Condition Specific to this Consent:
(1) The Division's contractors shall comply with the provisions established in the
separate agreement between MK-Menlo II Property Owner LLC and the
Division's Contractor.
By signing this consent document, I acknowledge that I am the legal property owner or tenant
in residence that has the authority to allow this work on the property and have contacted all
tenants (if there are tenants) occupying the property and all tenants agree to the conditions
of this "Property Access Consent".
April 28, 2020
(Signature of Property Owner or Tenant in Residence) (Date)
(Telephone Number for Property Owner or Tenant in Residence for scheduling work/notification)
(Email Address for Property Owner or Tenant in Residence if you prefer to be contacted via
email)
E Q�
North Carolina Department of Environmental Quality! Division of Waste Management
217 West Jones Street 1646 Mail Service Center Raleigh. North Carolina 27699 Ib4b
919.707.8200

AGREEMENT FOR SITE ACCESS
THIS AGREEMENT is made and entered into by and between MK-Menlo II
Property Owner LLC and ATC Associates of North Carolina, P.C. (ATC).
RECITALS:
A. MK-Menlo II Property Owner LLC owns the Property located at 380 Western
Boulevard in Jacksonville, North Carolina.
NOW, THEREFORE, for and in consideration of the mutual covenants set
forth herein, the parties agree as follows:
Indemnification. ATC shall defend, indemnify, and hold harmless MK-Menlo II
Property Owner LLC and its tenants from and against any claim, cost, expense, damages,
fines, losses, or liability, including reasonable attorneys' fees, caused by, arising out of,
resulting from, or occurring in connection with the negligence or willful misconduct by ATC
in carrying out the activities authorized by this Agreement.
IN WITNESS WHEREOF, the parties hereby execute this Agreement.
MK-Menlo II Property Owner LLC
By. AAA..
ATC
Date: April 28, 2020 Date: May 6, 2020

13'
A' C
JrAtT
N
ENVIRONMENTAL • BEOTECHNICAL
2725 E. Millbrook Road, Suite 121
Raleigh, NC 27604
[phone]
PROJECT NO: DC670011
Well finished at surface with locking
well cap and 8" diameter flush -
mounted manhole cover with 2' by 2'
concrete pad.
Cement Grout Extending From Ground Surface
To Top of Bentonite Seal
2" Diameter Schedule 40 PVC Casing Extending
From Ground Surface to Top of Screen (0-3 feet)
6-Inch Bentonite Seal
10 Feet of 2" Schedule 40 Well Screen (0.010" Slot)
(3-13 feet)
Groundwater Table
#2 Filter Sand Pack Extending 6-Inches Above Screen
WELL
CONSTRUCTION DIAGRAM
Coastal Cleaners
345 Western Blvd.
Jacksonville, Onslow County, NC 28546
DATE: 08/2020
REVIEWED BY: AW
DSCA ID: DC670011

LEGEND:
MW-1
MONITORING WELL
'---
Well Identification
GW-3
TEMPORARY MONITORING WELL
'*-- Sample Identification
— - - —
SITE PROPERTY LINE
PARCEL LINE
FENCE
ST
STORM SEWER
—E—E—
ELECTRICAL UNDERGROUND
F—
FIBER OPTIC
w—w—
WATER LINE
—c—c—
CABLE LINE
u—
UNKNOWN UTILITY
NATURAL GAS
©
UTILITY POLE
®
UTILITY POLE/TRANSFORMER
©
CABLE PEDESTAL
O
WATER METER
®
STORM SEWER
O
BOILER
©
COMPRESSOR
0
DRYER
0
WASHER
RR
RESTROOM
PCE ISOCONCENTRATION CONTOUR
—0.07—
(DASHED WHERE INFERRED)
NOTE: ALL LOCATIONS ARE APPROXIMATE
AP
/F
F W
i
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m�\ c
COMMUNICATION BOX
GW 6 - \
4/9/2018 m
Constituent mg/L \
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MW-2
6/12/2019
Constituent I m /L
Tetrachloroethylene 1 <0.000500
GW-7
4/9/2018
Constituent me/L
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E
h"M
GW-5
4/9/2018
Constituent
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RR
0
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RO
CLEANING MAC
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4/9/2018
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F /
SB
a
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RITA'S ITALIAN ICE
GW-1
4/9/2018
Constituent
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0.001
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i
-3
00l qR
0007/
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GW-
k
J
,r GW-1
MW-3
6/12/2019
Constituent
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0.000763
Vinyl Chloride
0.000238J
MW-1
6/12/2019
Constituent I mg/L
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Vinyl Chloride 0.00173
r.
JFF\
N m %
GW-4
GW-2
4/9/2018
4/9/2018
Constituent
mg/L
0.44
Constituent
Tetrachloroethylene
rachloroethylene
ichloroethylene
0.012J
�,MW-4
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M W-4
6/12/2019
Constituent
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0.12 km
U.S. Fish and Wildlife Service, National Standards and Support Team,
vvetlands—[e-mail]
2020